Archive for the ‘Resources’ Category

California’s Timely Access to Medical Care

Sunday, February 14th, 2010

 Recently, the California Department of Managed Care has released some new guidelines for HMO patients, in order to create a more efficient and comprehensive level of care for these patients. Among the new rules:   

• A physician appointment within 10 business days of a request 

• A specialist appointment within 15 business days of a request 

• An urgent care visit within 48 hours of a request 

• Telephone access to a health care professional at all times.  

The state is giving health plans one year to comply with these new regulations. After the one year grace period, non-compliant carriers will face heavy fines. With the implementation of these new rules, it is hoped to reduce emergency room traffic, as more patients are able to obtain urgent care visits instead, as well as the overall reduction of appointment wait times (which benefit all patients – HMO and PPO alike).  

Opponents to these new regulations feel that this adds to an already strained system of primary care physicans, who are already in shortage. Fears also lie in the fact that the doctor would now be forced to spend less time with each patient. However, with the average waiting time to see a general practitioner at 20 days, it does seem that the pros outweigh the cons with these timely-access rules.

Is There a Answer for COBRA Subsidies?

Monday, January 18th, 2010
Worries grow as those Californians who have been receiving assistance with their COBRA premiums are faced with losing financial assistance. As federal stimulus money dwindles, the 65% of premium formerly covered by this subsidy will expire, leaving many to make a tough choice – pay the premiums or go without coverage. COBRA (the Consolidated Omnibus Budget Reconciliation Act) was passed in 1985, allowing involuntarily terminated employees to keep their current health plan, and take over the payments for their monthly premiums. However, after many years and skyrocketing health care inflation, many people are finding that their COBRA premiums are exceeding their unemployment benefits.
 
If reports are correct in showing that 40% of newly employed people applied for the COBRA subsidy, these numbers can mean that the number of uninsured people will rise along with the lack of federal support. There are some plans in the works, however, which may bring some much needed relief:
 
HR 3930 would extend the period of eligibility through June 2010, increase the maximum duration of the subsidy to 15 months and end all subsidies at the end of December 2010.
 
S 2730 by includes the same provisions as the House bill and would also increase the federal subsidy from 65% of the premium to 75%, as well as expand eligibility to include employed people who lose health coverage because of involuntary reduction of hours.
 
COBRA Subsidy Laws are changing all the time. We will try and bring you the most updated information as we can. In the meantime, there are many websites to help you keep up with the changes. We are also happy to answer any questions you have!

Blue Shield of California Cancellations for Non-Payment of Premiums

Thursday, December 24th, 2009
Important news for our Blue Shield of California clients who are currently on individual and family plans. If you miss a payment, and exceed your grace period, they will no longer reinstate you after January 1, 2010. In these cases you will have to reapply for coverage and be subject to medical review once again. You are not guaranteed approval, even though you were a recent member.
 
We will make every effort to give you updates if you show late on payments. Not only will we send you email reminders, Blue Shield will also send you late payment notices via mail. Make sure to send in your premium, or contact us to set up monthly automatic payments via credit card or checking account to avoid cancellation.

The Medical Information Bureau and You

Thursday, December 17th, 2009

Is there a database out there with all of your medical information available to prospective and current insurers? No. However, there does exist a shared central database called the Medical Information Bureau that may contain some important medical information about you. This data base is used primarily by insurance companies when applying for individual or life insurance. These companies can use information in the MIB’s database to help make a decision as to whether or not you will be offered coverage. 

 
However, based on HIPAA laws, this database does not include your entire medical history, doctor’s chart notes, etc. Instead, information in MIB reflects medical conditions (such as diabetes and high blood pressure) or lifestyle choices (i.e. skydiving or smoking) that are thought to be significant. While the decision to decline coverage is not solely based on reports in the MIB, it definitely plays a strong role.
 
It is very important that you monitor information in the MIB as you would with anything else, such as your credit report. If you note any incorrect information, you can work to have it corrected, and not hinder your chances of obtaining health or life insurance in the future.

Children with Insurance Have Brighter Prognosis in Hospitals

Thursday, December 10th, 2009

Disturbing news shows that children without insurance are 60% more likely to die from a serious illness, such as pneumonia or asthma. This is most likely due to the fact that care is not sought out until it is much farther advanced. This is tough to swallow, but keep in mind there are always options to ensure that your children are not without the coverage they need.

 The best news this year is the fact that Healthy Families (medical, dental and vision coverage for California children) has received much needed funding, and is now enrolling new members once again. In addition, many carriers have released catastrophic plans, which ensure low cost coverage for times when you need it most. There are also plans that offer coverage for immunizations and preventative care, allowing your child to keep as healthy as possible, and avoid trips to the emergency room altogether.

 We will help you find the best coverage for your child. Call us today or visit the website for a quote today!

Do Americans Really Pay More For Their Health Care?

Thursday, December 3rd, 2009

Recent studies show that the United States spends almost 44% more for health care than Switzerland, though Switzerland has the second higher per capita health care costs. Even with these escalated costs, Americans have fewer visits and spend less time with their doctors, as well as experience shorter hospital stays than any other industrialized nation.

The reason for this is also one of the strongest arguments for health care reform: Americans pay more for the same level of care than anywhere else in the world. Part of the problem lies in the fact the governments set the rates that will be paid for different treatments and drugs in other countries, while this is not the case here in the United States. This results in private insurers paying higher rates for the same services – at times astronomically higher — as they are carrying the load of negotiating fees. This results in a trickledown effect as consumers face skyrocketing insurance premiums, and ever higher deductibles and coinsurance.

As Americans, we need to take control of our health care costs and re-evaluate what we consider “medically necessary”. The latest and greatest technology, though nice to have on hand when necessary, should really only be used if they achieve a desired clinical benefit. By controlling unnecessary spending, we can curb excessive spending, and put the money back in our pockets for when we really need it.

Anthem Blue Cross PPO Share Plan Changes

Monday, November 16th, 2009

Anthem Blue Cross has discontinued some of their PPO Share (maternity) plans in California, and although you may keep your current coverage, you may find the rates higher than you anticipated. In this case, new plans have been designed to offer comparable coverage with lower premiums. For instance, those individuals and families on the PPO Share 2500 or 1500 may want to consider moving to a less expensive plan, such as the PPO Share 3500. These plans will balance the escalating costs of maternity coverage with higher deductibles and out of pocket maximums. You will still have the comfort of knowing that your coverage is in place should you need it, and continue using your current doctors and hospitals. Also, moving to a new plan will not always require medical review, making the process even easier.
 

As your agent, we also suggest reviewing options for those family members who do not need maternity coverage, and consider separate plans for your family members. You’ll find that this can often reduce your overall premiums, as you are no longer paying for coverage you don’t need.

Lack of Health Insurance Can Mean Financial Ruin

Saturday, November 7th, 2009
We all know that changes need to be made in the health insurance industry, though no one as much as someone who experienced a major illness without health coverage. For those who are nearer to retirement age, a major illness (i.e. cancer or heart disease) can mean a loss of close to half of their household assets in order to get the medical care they need. This loss is more severe for the uninsured ages 51 – 64 as they have accumulated greater assets for retirement, along with fewer options to re-establish these assets if they are lost due to an illness. The situation in these cases can mean a financial disaster.

It is vital to ensure that your assets are protected, and even more imperative that care is sought out in the case of an illness. Treating conditions earlier mean a better chance of recovery, and better quality of life. Even basic insurance can help you avoid catastrophic losses, and the added support from a Long Term Care policy will help you protect your future, and your family’s as well. Contact us today to see how we can help you protect your health and your peace of mind.

Expiration Date Nears for COBRA Federal Subsidy

Monday, November 2nd, 2009
The federal economic stimulus package which covers 65% of the cost of COBRA premiums is set to end as of December 2009. This reduction was designed to assist those who had an involuntary termination of employment and were eligible for COBRA during the period of September 1, 2008 through December 31, 2009. Though the subsidy is set to end after a period of 9 months, this does not mean you are going to lose your coverage. Instead, you will now be covering the entire cost for the remainder of your 18 months, or longer if your coverage is eligible for extension. The subsidy will end prior to the 9 months in the case of eligibility for coverage under a new group plan, eligibility for Medicare, or in the case of non-payment of the remainder of the COBRA premiums.
 

Let us help you find alternate coverage before your COBRA expires. There are many options for you and your family, and we are happy to help you determine whether a new plan is the best route, or to stay on COBRA for the remainder of your eligibility period.  It is our pleasure to help you determine the best choice for your health insurance coverage.

H1N1 Flu Vaccine and Your Insurance Plan

Monday, October 12th, 2009
Many carriers have released information that they will be covering the H1N1 virus (swine flu) vaccine and all administrative costs associated with obtaining the vaccine. Although focus will start with clients at most risk, all members will be ultimately covered. The two anti-viral medications, Tamiflu and Relenza, both offered in a generic formula as well, will be covered under the Tier 1 benefit, which ensures the lowest copayment for members to get their medications.
 
Companies that have agreed to this thus far are Blue Shield of California, Aetna, and BCBS IL, with more carriers joining in every day. Please contact us or check your insurance companies website to see how they will help you to protect yourself and your family members.
 
Note:
It is important to understand that these benefits are subject to the vaccine’s availability.  The CDC is working with local health departments to ensure the following targeted priority populations receive the vaccine first:
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Healthcare and emergency medical services personnel
4. Persons between the ages of 6 months through 24 years
5. People ages 25 through 64 years who have chronic health disorders or compromised immune systems.

© 2009 Abrams California Health Insurance Agency. All rights reserved.
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